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Monday, July 07, 2008

Medical Marvel: Pruritus

Pruritus, you say? Plain ol' itching? How could that be a medical marvel? Yet, in his new piece for The New Yorker, Atul Gawande manages to do just that. Like most people, I have not given itching much thought (except when I have one), but "The Itch" shows what happens when pruritus is taken to the extreme:

“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.” For M., certainly, it did: the itching was so torturous, and the area so numb, that her scratching began to go through the skin. At a later office visit, her doctor found a silver-dollar-size patch of scalp where skin had been replaced by scab. M. tried bandaging her head, wearing caps to bed. But her fingernails would always find a way to her flesh, especially while she slept.
One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night—and all the way into her brain.

And if you think that is nuts, read the whole article. Done reading? Have a few questions about how real all that stuff is? Check out this Q&A with Gawande about some of the more incredulous points in the piece. And, if you're still curious, keep on reading at Gawande's personal website or check out one of his books: